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Role of Exercise in the Prevention of Coronary Heart Disease in Women

Dra. Patricia Sangenis

Médica cardióloga y especialista en medicina del deporte
Directora del Instituto " Deporte y Salud " de Buenos Aires
Miembro del Comité Ejecutivo de la Federación Internacional de Medicina del Deporte
Miembro de la Comision Médica del Comité Olímpico Internacional
Miembro Fellow del American College of Sports Medicine

The Health Dividend of Physical Activity
References
Addendum (Spanish)


Women have been poorly active until recent years. During many years young girls and women in general were discouraged to participate in sports, exhaustive training and competition.

The underlying idea was that physical activity could harm the reproductive system, diminishing fertility.

... Beside they were unable to withstand prolonged mental and physical strain...?

Women who participated in sports were thought to develop a masculine appearance...

 

Another interesting concept was that women had a weaker heart...But time passed and the evolution of women performance in sports, some amazing records compared to men´s and mothers who became world champions, made the sport scientists doubt of these concepts.

The Health Dividend of Physical Activity

Evidence of the multiple benefits of regular physical activity is extensive. Exercise can aid in the Prevention and management of:

Coronary Heart Disease
Hypertension
Non insulin dependent diabetes
Osteoporosis
Obesity
Depression and anxiety
Reduced rates of lower back injury
Stroke
Lower rates of certain cancers? (colon, breast and certain reproductive cancers).

Today we know that cardiovascular disease is the leading cause of death in women. In many countries it claims more lives than all forms of cancer, accidents and diabetes combined.

Why is still the general misconception that coronary heart disease is a men´s disease?. It has only a later onset in life, but has a worse prognosis for women with both medical and surgical therapies. Even th rate of early death after a myocardial infarction is higher for women.

Misperception of angina pectoris in women may delay the evaluation, increasing the risk.

Women are even referred for revascularization at a later stage of illness, and have higher operative mortality rate periprocedural complications with coronary bypass surgery.

The rate at which coronary atherosclerosis progresses, will be mainly determined by lifestyle factors such as physical activity, diet, smoking and stress.

Epidemiological studies show a strong, graded, and consistent inverse relationship between physical fitness/ activity and coronary heart disease / mortality in both men and women, which is not confounded by age or other risk factors.

The representation of women in prospective studies has been inadequate. Therefore it is difficult to determine possible gender differences in heart disease risk.

There is now evidence that coronary heart disease risk factors are shared by women and men.

There are some factors under study that uniquely may affect women´s cardiovascular system: the use of contraceptive and postmenopausal hormone replacement.

Physical activity might play an important role in preventing or delaying the onset of coronary artery disease.

The mechanisms may be:

Risk factor reduction with physical activity
Physiological adaptations with training.

The dose-response relationship between exercise and health status, suggests that modest increases in physical activity elicit a positive health impact, which is particularly important for the lowest fit people who may be discouraged or intimidated by vigorous exercise protocols.

It is beneficial, therefore, to encourage any efforts a woman can make to increase the average weekly caloric expenditure and establish the base for a more active lifestyle.

References:

1-Blair, S.N., H. W. Khol, R. S. Paffenbarger, D.G. Clark, K. H. Cooper, and L. W Gibbons ( 1989 ) Physical Fitness and all-cause mortality: A prospective study of healthy men and women. J.A.M.A. 262:2395- 2401
2-Depres,J.P., Pouliot, S. Moorjani, Bouchard C. . Loss of abdominal fat and metabolic response to exercise training in obese women. Am. J. Physiology : Endocrinology and Metabolism. 261: E159-E167 (1991 )
3-Drinkwater, B. L. . Physiological responses of women to exercise. In : Exercise and Sport and Sciences Review. Academic Press, Inc. 1973 pp 126-133
4-Ekelund, L., W.l. Haskell, Y.L.Troung, E.H. Gordon, and D.S. Shepps (1988). Physical fitness as predictor of cardiovascular mortality in asymptomatic females. Circulation 78 : ( supplement) 11-110 Abstract).
5-Friedman, T.D., Greene, A.C. Iskandrian Segal, B.L. Exercise Thallium-201 myocardial scintigraphy in women: correlation with coronary arteriography. Am. J. Cardiol. 1982, 49:1632-7
6-Haskell, W.L. (1984) The influence of exercise on the concentrations of triglyceride and cholesterol in human plasma. Exercise and Sport Sciences Reviews, 12, 205-244
7-Lerner, D.J., Kannel,W.B. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am. Heart J. 1986,111:383-90.
8-Wenger, N. K., Speroff,L, Packard,B. Cardiovascular health and disease in women. N. Engl. J. Med. 1993, 329:247-256.
9-Wilmore,J.H, Costill,D.L Physiology of Sports and Exercise. 1994. Human Kinetics.

Addendum (Spanish)

Programa de ejercicios para mujeres sedentarias:

Evaluación

1. prueba en bicicleta erguida o recostada (dependiendo del peso corporal) con control electrocardiografico continuo.
2. prueba en cinta deslizante progresiva (Bruce modificado)
3. Prueba de fuerza muscular
tren superior:     press plano en Smith
                            vuelos en maquina mariposa.
tren inferior :     semisentadillas sin peso
                            prensa horizontal
                            extension y flexion de rodilla en camilla
tren medio:         abdominales superiores cortos en 30"
                            abdominales inferiores
                            oblicuos
                            espinales
4. test de flexibilidad:
                            sit and reach o flexibilidad isquiotibiales y lumbares (flexion anterior de tronco)
                            toma de ambas manos en la parte posterior de la espalda.

Programa de ejercicios

Semana 1 a 3 :     combinacion de aparatos aeróbicos
                              tiempo 15 a 20 minutos
3 veces / sem        treadmill+ bicicleta+elíptico.
                                Fuerza muscular: solo grandes grupos musc.
                                tiempo 15 a 20 minutos
                                50 % de la fuerza máxima testeada
                                repeticiones : 15 a 20.
                                Flexibilidad : especialmente lumbar 10 min.

A partir de la 4a semana y segun tolerancia y disponibilidad se agrega una 4a vez de ejercitacion semanal.
Los trabajos aeróbicos se incrementaran 2 min por semana hasta llegar a 30 o 40 min de acuerdo a objetivos.
La fuerza muscular modificamos plan cada seis semanas promedio.
A partir de completar el 2do mes, se reevalua a la mujer en plan de ejercicios y se induce a agregar los días que no viene al Instituto una caminata de 20 a 30 minutos, para cumplir con las recomendaciones del A.C.S.M.
Entre el 3 y 4 mes reevaluacion y marcar nuevos objetivos y nuevo plan.

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Bioengineering

UNER
Update
01/21/2000 


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